Electromotive Drug Administration of Mitomycin C (EMDA/MMC) versus Intravesical Immunotherapy with Bacillus Calmette-Guérin (BCG) in Intermediate and High Risk Non Muscle Invasive Bladder Cancer.

BACKGROUND: Although TURB of tumor (TURBT) by itself can eradicate a non-muscle-invasive bladder cancer (NMIBC) completely, these tumors commonly recur and can progress to MIBC. It is, therefore, necessary to consider adjuvant therapy in most patients. The primary objective of the present study was to report our experience with EMDA/MMC and BCG, considering efficacy, progression, and recurrence, as adjuvant therapy in NMIBC patients; the secondary objective was to assess the efficacy of EMDA/MMC versus BCG as a comparative treatment. METHODS: Between April 2016 and February 2020, a series of 216 patients, with a diagnosis of intermediate- and high-risk NMIBC after TURBT, underwent adjuvant intravesical therapy. In 26 cases with a failure of the treatment, in patients unfit and unwilling for radical cystectomy, a repeated intravesical therapy was performed (2 had a twice repetition). Out of 244 adjuvant therapies, 140 EMDA/MMC and 104 BCG treatments were done. The following data were collected for each patient: baseline demographics and clinical data and perioperative and postoperative data. Overall patients' adjuvant intravesical therapies were included in a prospectively maintained institutional database, and a retrospective chart review was performed. We collected data on 2 main outcomes, recurrence-free survival (defined as a negative cystoscopy, cytology, and/or histology at the evaluation time point) and progression-free survival (defined as a negative cystoscopy or a nonprogressive tumor recurrence). RESULTS: The NMIBC progression rate was higher in BCG than EMDA/MMC but not statistically significant (respectively, 4.2% vs. 2.5%; p = 0.703). In the overall population, the risk of NMIBC recurrence was higher after BCG than EMDA/MMC (p = 0.025). In the subgroups of 59 paired patients with similar characteristics, no difference was observed between groups in NMIBC progression and recurrence. CONCLUSIONS: Our findings suggest that EMDA/MMC and BCG are safe and reproducible approaches as adjuvant treatment in NMIBC. EMDA/MMC permits to achieve a fine oncological management as adjuvant treatment in NMIBC, which is not less than that obtained with BCG.

The variation of selective uNGAL levels after robot-assisted partial nephrectomy: Early results of a prospective single center study.

OBJECTIVES: Acute kidney injury (AKI) secondary to nephron-sparing surgery represents a significant problem in order to preserve renal function. Since serum creatinine alone underestimates the early detection of AKI several biomarker have been investigated. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is considered a good biomarker for AKI. MATERIALS AND METHODS: We report our experience in 28 patients affected by localized renal cell carcinoma and submitted to robot-assisted partial nephrectomy (RAPN). In each patient selective urinary NGAL levels were dosed before surgery, then 2 and 48 hours after the procedure, through a ureteral catheter inserted into the excretory axis of the operated kidney. Moreover, we evaluated split renal function of the preserved renal parenchyma by a 99mTC-DTPA renal scintigraphy, performed before surgery and three months later. RESULTS: AKI was diagnosed, according to internationally criteria, in 3 patients (10.7%). The baseline selective urinary NGAL level was 20.02 ng/ml. This level significantly increased after surgery with a selective urinary NGAL level that reached 56.36 ng/ml (p < 0.0001). Moreover, a significant reduction in 99mTC-DTPA clearance of the operated kidneys after three months was detected (p < 0.0001). CONCLUSIONS: Selective urinary NGAL assay represent a sensitive biomarker of acute kidney injury after robotic nephron sparing surgery, capable of predicting the functional outcome of the operated kidney.

Could pollen extract in association with vitamins be favorable in the reduction of chronic prostatic inflammation? A case-series analysis.

The aim of the present case-series analysis was to assess the safety and efficacy of pollen extract in association with vitamins in order to reduce the chronic prostatic inflammation in patients with class IV chronic prostatitis (CP). Nineteen non-consecutive patients performed a prostate biopsy for a suspect of prostate cancer. The biopsy histopathological examination showed a class IV CP, in presence of mild/moderate/high degree of inflammation, in association with an extensive (multiple biopsy sites, i.e., ≥ 3) high-grade prostatic intraepithelial neoplasia PIN (HGPIN) and/or atypical small acinar proliferation (ASAP). According to EAU Prostate Cancer Guidelines prostate biopsy was repeated after 6 months, because of the presence of extensive HGPIN or ASAP. Oral administration of pollen extract in association with vitamins (two capsules every 24 h) was prescribed until the repeat biopsy. Repeat biopsy histopathological examination showed, in 13 patients (68.4%), a lower degree of inflammation (absent/mild/moderate).

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience.

BACKGROUND: Few studies have reported robotic pyelolithotomy (RPL) series; furthermore, the most of all have reported small and single-center series. Herein we report our experience from 70 cases of complex kidney stones treated with RPL at our surgical center; this study reports the largest series of RPL in a minimal invasive experienced center. METHODS: Between February 2016 and March 2018, 70 patients with complex renal stones (Guy's Stone Score: 4) underwent RPL and included in a prospectively maintained institutional database. Baseline characteristics, clinical data, perioperative data, postoperative data and stone free status were assessed by descriptive statistics. RESULTS: Of 70 patients, 72.85% presented renal pelvis stones. The mean maximum stone diameter was 33.1±14.5 mm (median 30 mm; interquartile range 22-40 mm). Mean total operative duration was 122.5±34.4 min (median 120 min; interquartile range 105-135 min). In two patients (2.8%), a grade III complications were noted; no major complications (grade IV-V) were noted. The complete SFR, after a single robotic procedure, was 92.8%. CONCLUSIONS: Our findings suggest that RPL is a safe, reproducible and minimally invasive approach as treatment of large renal stones when endoscopic treatment failed or was not available. RPL permits to achieve an excellent stone free status, in a single definitive procedure.

Extraperitoneal robot-assisted radical prostatectomy: a high-volume surgical center experience.

BACKGROUND: Herein we report our high-volume single center experience with extraperitoneal robot-assisted radical prostatectomy (eRARP) in patients with prostate cancer (PCa). METHODS: A retrospective chart review of our prospectively maintained institutional PCa database was performed to analyze eRARP cases done between April 2009 and March 2016. Nerve-sparing technique was applied in accordance with Tewari. Baseline characteristics, surgical outcomes, continence and erectile function were assessed by descriptive statistics. RESULTS: Of 1354 patients, 61% had intermediate-risk disease. Mean total operative duration was 146±44 min (median 140 minutes; interquartile range 120-160 minutes). In 91.7% of case no complication was recorded. Gleason Score on final pathology was mostly 6 (43.3%) or 7 (3+4) (32.3%). The pathological T stage was mostly pT2c (53.8%). Patients who had a bilateral nerve sparing procedure showed the best functional results, with 81.2% continence rate at 1 month, and 65% reported recovery of erectile function at 3 months postoperation. CONCLUSIONS: eRARP is a safe, reproducible, and effective procedure for the surgical treatment of prostate cancer. Superior functional outcome can be achieved when a bilateral intrafascial nerve-sparing approach can be performed.

Robot-assisted excision of seminal vesicle cyst associated with ipsilateral renal agenesis.

Seminal vesicle cysts (SVCs) associated with other genitourologic abnormalities are rare. Often associated with ipsilateral renal agenesis in a symptomatic patient. In symptomatic patients open surgical excision is the treatment of choice. The laparoscopic approach is a less invasive option. Recently robot-assisted management has gained a primary role for the treatment of this condition.

The use of autologous platelet rich plasma gel in bulbar and penile buccal mucosa urethroplasty: Preliminary report of our first series.

OBJECTIVE: The Buccal Mucosa (BM) UrethroPlasty (UP) is one of the preferred treatments for long or compli-cated urethral strictures. We propose the use of autologous Platelet Rich Plasma gel (aPRPg) in order to enhance to vascularization of BM graft and reduce the fibrous spongy. We report the outcome of our ten cases of bulbar and penile UP and the safety of this technique. Materials and metods: Ten patients underwent to BM UP with use of aPRP gel. Median age was 46. Stricture etiology was idiopathic, failed hypospadias and flogistic. Average stricture length was 3.7 cm. All patient were preoperatively evaluated with uroflowmetry , retrograde urethrography, cystoscopy and questionnaire. The harvesting of the aPRP was performed in blood bank from peripheral venous sample. Catheter was usually removed after 3 weeks and urethrography was performed after 6 weeks. RESULTS: All patients reported no problem on the donor site. At time of follow-up (median 20 month, 12-34) all patients refer no problem and a good uroflowmetry. No re-strictures at the anastomotic sites were demonstrated in any of the patients. CONCLUSION: However in our experience the follow-up is limited and no definitive conclusion or comparison can be made with the original BM UP. The use of aPRP gel seems feasible and safe. In our opinion it is important to continue investigating this procedure for its advantages in case of complex urethral strictures complicated by fibrous spongy, above all in penile urethral strictures post hypospadia repair.

Influence of hCG on inducible nitric oxide synthase gene expression in ram testicular arteries.

UNLABELLED: Background. Experimental evidence suggests a relationship between the vasodilatory effect of hCG and the NOS system in the testis. The influence of hCG administration on testicular vascular NOS gene expression has not been fully investigated. OBJECTIVE: This study aimed to evaluate the presence of the nitric oxide syntheses gene in ram testicular arteries and the influence of hCG administration on its expression. MATERIALS AND METHODS: Both testicular arteries of sixteen rams were extracted before and after i.v. administration of 5000 IU of hCG or placebo. The expression of the iNOS gene was investigated by real time PCR. Data were analyzed by means of Wilcoxon and Mann-Whitney tests. A p value of < 0.05 was considered statistically significant. RESULTS: PCR revealed the presence of iNOS mRNA in all basal samples but the expression of the iNOS gene was significantly reduced in all arteries obtained 24 h after the administration of either hCG or placebo. A significant reduction in the expression of iNOS gene was observed in the testicular arteries extracted after 24 h in both treated and placebo groups. On the other hand hCG stimulation did not significantly influence iNOS expression following its administration compared to a placebo. CONCLUSION: Ram testicular arteries express the iNOS gene but hCG stimulation did not significantly influence iNOS expression. A significant reduction in the expression of this gene was observed in the testicular arteries extracted after 24 h in both treated and placebo groups, suggesting that iNOS expression on the testicular artery could be influenced by the spermatic vessel ligation of the controlateral testis.

Expression and hormonal modulation of the thromboxane A2 receptor gene in mammalian testicular arteries.

OBJECTIVE: Thromboxane A2 (TXA2) is a biologically potent arachidonate metabolite which causes vasoconstriction and platelet aggregation. This study aimed to evaluate the presence of TXA2 receptors in mammalian testicular arteries and the influence of exogenous gonadotropin administration on their expression. DESIGN: Experimental study. SETTING: Experimental animals in an academic research environment. ANIMAL(S): Seven rams aged 4-6 years, weighing 60-90 kg. INTERVENTION(S): Both testicular arteries of seven rams were extracted before (from one testis) and after (from the opposite testis) IV administration of 5,000 IU human chorionic gonadotropin (hCG). MAIN OUTCOME MEASURE(S): The expression of the TXA2 receptor gene was investigated by the real-time polymerase chain reaction. Data were analyzed by means of Student t test. Results were expressed as mean +/- standard deviation. A P value of <.01 was considered statistically significant. RESULT(S): Polymerase chain reaction revealed the presence of TXA2 messenger RNA receptor in all the basal samples, but the expression of TXA2 receptor gene was undetectable in all the arteries obtained 24 h after the administration of hCG. CONCLUSION(S): These preliminary results demonstrated for the first time the presence of TXA2 receptors in mammalian testicular arteries. Results also showed that their expression was down-regulated after hCG administration.

Detection rate of ultrasound vs CT scan in clinical staging accuracy of renal tumors pT1NxMx.

OBJECTIVE: Renal ultrasound is very important in the diagnosis of renal tumors. MATERIAL AND METHODS: From January 2000 to Jannuary 2005 we retrospectively examined the records of 116 patients, 37 women and 79 men (mean age 54 years, range 22-77), who underwent radical nephrectomy for kidney cancer in clinical stage CT1N0M0. 2.5 cm was the tumor dimension limit between the nephron sparing surgical technique and radical nephrectomy. We subdivided the sample into 2 groups, the first of 45 patients with tumor lesions smaller than 2.5 cm and the second with tumor lesions between 2.5 cm and 7 cm in diameter all patients underwent preoperative staging including ultrasound scan (ETG) and computer tomography scan (CT). RESULTS: Ultrasound has showed 35% sensitivity and 49% specificity for lesions under 2.5 cm in diameter, and 65% sensitivity and 75% specificity and 80% specificity for lesions under 2.5 and 80% sensitivity and 95% specificity for lesions between 2.5 and 7 cm. CONCLUSIONS: Ultrasound is the first step in the staging of renal cancer before surgery; to assess. 2.5 and 7 in diameter CT scan is the gold standard for solid and cystic lesions.

Penile Doppler ultrasound assessment of the cavernous arteries.

OBJECTIVE: To evaluate the possible relationship between the basal and dynamic diameter of the cavernous arteries and altered peak diastolic (PDV) and systolic values (PSV) in patients undergoing penile Doppler ultrasound for differential diagnosis of erectile dysfunction (ED). MATERIALS AND METHODS: From December 2003 to December 2004 we examined 132 consecutive patients suffering from erectile dysfunction and 30 controls. All patients underwent penile Doppler ultrasound in basal and dynamic conditions and all the examinations were performed by measurements of the cavernous arteries diameters in basal and dynamic conditions. RESULTS: In the 30 healthy controls the mean cavernous arteries diameter was 0.82 mm (range 0.6-1.3 mm) on the right and 0.8 mm (range 0.5-1.25 mm) in basal conditions vs 1.30 mm (range 0.9-1.6 mm) on the right and 1.25 on the left (range 0.9 -1.60 mm) in dynamic conditions after injection of 10 microg. In the 132 patients with a diagnosis of organic ED, the mean diameter was 0.70 mm (range 0.3-1.3 mm) on the right and 0.76 mm (range 0.3-1.24) on the left in basal conditions vs 1.21 mm (range 0.8-1.93 mm) on the right and 1.24 mm (range 0.9-1.66 mm) on the left in dynamic conditions after injection of 10 microg. CONCLUSION: In our experience, assessment of the cavernous arteries in basal and dynamic conditions provides important additional data. Altered basal and dynamic values are predictive of anomalous PDV and PSV findings.